Objective: Weight status at age six years has been identified as an important predictor of overweight and obesity in adolescence, which, in turn, tracks into adulthood, increasing the risk of future metabolic diseases. This study aimed to describe the prevalence of overweight and obesity in six-year-old children in 4th and 5th quintile schools in Mangaung as part of a campaign to raise awareness of the problem among parents and educators.

Design: The study design was cross-sectional and descriptive.
Subjects and setting: Ninety-nine randomly selected grade 1 children, born in 2007, in 4th and 5th quintile primary schools, Mangaung, were the study subjects.
Method: Body mass index (BMI) and waist-to-height ratio (WHtR) were recorded.
Results: Based on BMI-for-age, 24.2% of the children were overweight and obese (10.9% of the boys and 11.3% of the girls were overweight; and 10.9% of the boys and 15.1% of the girls were obese). WHtR was above normal in 16.2% of the study sample (8.7% of the boys and 22.6% of girls). WHtR correlated significantly with BMI (R 0.8, p-value < 0.0001) in this sample.
Conclusion: Almost a quarter of the six-year-old children in this study were overweight and obese. Parents need to be made more aware of future morbidities associated with excess weight at this age and be empowered to prevent, recognise and appropriately address weight problems in their children.

The Editor and the Editorial Management Board would like to express their sincere appreciation to our reviewers, the guardians of the scientific standing of the SAJCN, and acknowledge their contributions to the SAJCN's review process in the past year.

A healthy school environment, including healthy food environments within schools, has been a focus area in the global health arena for a number of decades. During the 1990s, the World Health Organization (WHO) published a series of technical documents that focused on the various aspects thereof. The aim of the WHO's Global School Health Initiative was to help schools to improve the health of students, staff, parents and community members. However, the rising tide of noncommunicable diseases (NCD) shifted the focus from general health promotion to an interest in schools as settings for NCD prevention, especially with regard to nutrition and physical activity behaviour. The dramatic increase in the prevalence of obesity in children around the world resulted in even greater interest being paid to school-based obesity prevention programmes. A 2011 Lancet series on obesity identified the key action that international agencies, the private sector, civil society, health professionals and individuals need to perform to combat the obesity epidemic. Creating a healthy school food, and physical activity, environment, was included as a priority action for individuals.

Objective: The objective of the study was to identify and categorise factors that influence the choice behind the purchase of an infant formula brand by mothers and/or caregivers, and the reasons for their choice.

Design: This was a descriptive cross-sectional study in the quantitative research domain.
Setting: The setting was a pharmacy in Centurion Mall, and large food retail stores in Centurion Mall, Centurion Lifestyle Centre, Lyttleton Centre, Attlyn (Atteridgeville) and the Quagga Centre (Pretoria West) in Tshwane Metropolitan Municipality, South Africa.
Subjects and outcome measures: The 200 participants who were selected using purposive sampling completed a point-of-purchase questionnaire.
Results: The majority of the participants who purchased infant formula were aged 25-34 years, married, educated, affluent and employed full-time. Influencing factors were advice from others [76% (of which 32% was advice from a paediatrician)], a perceived claim that the infant formula provided a specific health benefit (49.5%), brand loyalty (13.5%), having seen an infant formula being used in hospital (10.5%) and the infant's taste preference (9%). Half of the participants (51%) purchased infant formula manufactured by one of the largest manufacturers of this product globally.
Conclusion: Paediatricians' recommendations, as well as perceived health claims, were considered to be primary influencing factors with regard to the purchase of infant formula by mothers. Appropriate training should target paediatricians and other healthcare professionals to ensure that they advocate breastfeeding uncompromisingly, and advise mothers and/or caregivers on appropriate indications for infant formula.

Objective: Obesity, a global epidemic and risk factor for many noncommunicable diseases, has become a public health concern in South Africa,especially in the elderly. This study investigated the trend of development of obesity in a group of urban elderly individuals from 2007-2011.

Design: This was a cross-sectional or cohort design.
Setting and subjects: The study took place in Sharpeville, Gauteng, on 208 purposively selected elderly individuals aged 60-104 years.
Outcome measures: Measurements included anthropometric variables, i.e. weight, height and waist circumference, measured biennially from 2007-2011 using standard techniques. Collected data were analysed using Statistical Package for Social Sciences®, version 20.0. Descriptive analysis was performed for the variables, as well as Student's t-test, analysis of variance, correlation analysis and bivariate logistic regression.
Results: The mean body mass index (BMI) of the elderly participants ranged from 30.7 kg/m2 in 2007 to 31.1 kg/m2 in 2011, with a slight decrease in 2009 (29.5 kg/m2) in the women, and a reduction from 27.2 kg/m2 to 24.2 kg/m2 in the men. The combined prevalence of overweight and obesity increased from 72.9% in 2007 to 83.3% in the women, whereas it decreased from 66.7% to 42.8% in the men. The prevalence of central obesity fluctuated in the women (it decreased from 84.5% in 2007 to 72.0% in 2009, and then increased to 87.0% in 2011), while it decreased consistently in the men from 46.2% in 2007 to 28.6% in 2011. Overweight and obese elderly individuals (BMI ≥ 25 kg/m2) were more likely to be centrally obese than those with a BMI < 25 kg/m2.
Conclusion: The trend of obesity was consistently high in the study population from 2007-2011. However, a significant difference in the prevalence of total and central obesity was not noted, although it apparently increased in the women and decreased in the men. Appropriate and timely intervention is urgently required.

This debate was brought to the fore following the discussion on the presentations by two discussants, Prof Timothy Noakes and Prof Jacques Rossouw (alphabetical) at the 2012 University of Cape Town Faculty of Health Sciences centenary debate. The manuscripts of the discussants appear in this issue of the SAJCN, and are published without undergoing the journal's peer-review process.

Our human ancestors thrived on a diet high in fat and protein of animal or fish origin for at least 2.5 million years. Foods with a high-energy content and nutritional density were required for the development of the large, energy-expensive human brain. A reduction in human height and deterioration in our health followed the introduction of agriculture 2 000-12 000 years ago. In 1977, the United States Department of Agriculture (USDA) introduced novel dietary guidelines based on an untested hypothesis of Keys that dietary fat, especially of animal origin, increases the blood cholesterol concentration, 'clogging' the coronary arteries and causing heart attacks, i.e. the diet-heart hypothesis.

The biology of lipoproteins and lipoprotein particles as mediators of atherosclerosis has been documented extensively. Numerous prospective epidemiological studies have shown a robust relationship between low-density lipoprotein (LDL) cholesterol, or particles bearing apolipoprotein B, and increased risk of coronary heart disease (CHD); and between high-density lipoprotein (HDL) cholesterol or particles bearing apolipoprotein A1, and decreased risk. These relationships are present across the age spectrum and in both sexes. The causality of LDL cholesterol for CHD has been established by the clinical trials on cholesterol lowering and the Mendelian randomisation studies. However, clinical trials that focus on raising HDL cholesterol, or lowering triglycerides, have yielded mixed results, and the Mendelian randomisation studies have generally not supported causality. Research on the effects of diet on serum cholesterol led to public health guidelines, whose implementation within the last five decades was accompanied by lower population cholesterol levels and CHD burden in all of the countries studied. Over the last three decades, the favourable trends in cholesterol levels and CHD have been supported by the increasing use of statin drugs and improvedtreatments for myocardial infarction.

Human feeding studies show that dietary fat quality, but not total fat intake, influences levels of low-density lipoprotein (LDL) cholesterol. Meta-analyses indicate an association with reduced coronary heart disease (CHD) risk when saturated fatty acid is replaced with polyunsaturated fatty acid or with low-glycaemic index carbohydrates. A meta-analysis of eight small trials supports this benefit. Secular trends in populations that modified fat intake and quality show a consistent reduction in LDL cholesterol levels and CHD risk. The increase in obesity and diabetes in many developed countries does not track consistently with the implementation of dietary guidelines aimed at lowering fat intake. Obesity is more likely to be due to increases in total energy intake, coupled with an increasingly sedentary lifestyle. However, cohort studies indicate that poor dietary quality is associated with future weight gain. Both cohort studies and secular trends implicate the increased consumption of sugar-sweetened beverages as being associated with obesity, diabetes and cardiovascular disease. Weight reduction can be achieved with a range of energy-restricted diets, including low-fat, high-carbohydrate diets and low-carbohydrate, high-fat diets. Metabolic benefits are proportional to the degree of weight reduction, irrespective of the dietary approach used. The prevention of CHD requires an emphasis on fat quality, rather than fat quantity, while the prevention of obesity and diabetes requires a focus on energy balance and carbohydrate quality.

The following case study was discussed at the South African Society for Parenteral and Enteral Nutrition (SASPEN) workshop on critical care nutrition held at the 25th Congress of the Nutrition Society of South Africa and the 13th Congress of the Association for Dietetics in South Africa in Johannesburg in September 2014. It is a reflection of the general opinion of the audience, followed by a rationale of the latest literature on the topic. Here is a summarised discussion of the case.

Objective: The objective was to determine the nutritional environment at secondary schools in Bloemfontein, Free State province.

Design: This was a cross-sectional, descriptive study.
Subjects and setting: The subjects were secondary school principals in Bloemfontein, Free State province, in 2006.
Method: Principals of 10 secondary schools who were already participating in a larger study on 26 schools completed structured questionnaires on nutrition practices.
Results: Four schools utilised nutrition education programmes. None had vending machines. Two schools sold dairy products. Biscuits and chocolates were sold at eight schools, and sweets, crisps and fast food at all of the schools.
Conclusion: The nutrition environment at Bloemfontein secondary schools does not support healthy eating habits. Nutrition policies need to be introduced to improve the nutritional environment at schools as the available food for learners at the tuck shops and/or via the vendors was mostly unhealthy.

We are excited to announce that Practice-based Evidence in Nutrition® (PEN®) will be available to all full and associate ADSA members soon. Look out for the communication on when it will be accessible, and for details of informative training sessions that will be delivered by the international PEN® team.

The SASPEN President, Arina Prins, attended the European Society for Clinical Nutrition and Metabolism (ESPEN) Council meeting in Nice in January 2015. The meeting provided insight into and clarity with regard to the benefits for ESPEN block members. The outcome of the negotiations is that ESPEN's Life Long Learning courses may become a future SASPEN activity. In order to reap the benefits of thecollaboration with ESPEN, dietitians need to be SASPEN members and ESPEN block members. Further details can be obtained from the SASPEN website at www.saspen.com.